Technical Field
Non-limiting exemplary embodiment(s) of the present disclosure relate to medical data information systems and, more particularly, to a cloud-based system, method and computer program product for obtaining and transferring diagnostic images to a secure data repository for archiving, accessing and future retrieval by patients, medical care providers and medical insurance providers.
Background
Duplication and Inappropriate Utilization of Diagnostic Imaging Services
The Journal of the American Medical Association along with other industry medical experts have cited that up to 25% of imaging tests were ordered inappropriately or for defensive medicine purposes only. This results in an estimated cost of $30 billion dollars or more and continues to rise yearly. Physicians self-referring for diagnostic imaging constitutes up to a 54% increase in imaging tests performed in non-hospital facilities in which the referring physician has a financial interest. The American Journal of Radiology cited this in a study concerning physicians self-referring to their own facilities. The Center for Information Technology Leadership at Harvard University identified that over 20% of hospital radiology tests are duplicates which represents approximately $20 billion of wasted spending a year nationwide.
Claim Fraud and Abuse
The U.S. Federal Government through the division of the F.B.I.'s Strike Force has estimated that $178 billion dollars of claim fraud and abuse occurred in 2010. They expect this number to reach $239 billion in 2015. Radiology comprises 3% to 10% of this nationwide problem based on opinions of medical experts.
Technical Quality of Images Lack Quality Assurance Validation
Board Certified Radiologists have identified that over 20% of the studies performed in the U.S. lacked technical image quality sufficient to make an interpretation and diagnosis.
Inability to Easily Search and Identify the Modalities Performed by Diagnostic Providers
Insurance companies and government sponsored programs do not have the ability to readily identify the specific modalities performed by diagnostic providers. Medical management and nurse case management departments often need to perform research and make calls to determine the availability of modalities and procedures performed by their participating providers.
Diagnostic Imaging is not Appropriately Applied to Potentially Preventable Conditions and Hospitalizations
The Agency for Healthcare Research and Quality has identified that over $29.6 billion in national medical costs are associated with potentially avoidable hospitalizations.
Inability to Generate Comprehensive Data and Analytics for Imaging and Radiology
Managed Care Organizations have difficulty in managing the costs and quality associated with imaging and radiology services. Insurance industry experts have identified that data and reports are not readily available for managing radiology and imaging services.
Diagnostic Imaging Clinical Appropriateness
Managed Care/Insurance organizations need the ability to identify the clinical appropriateness of authorizing radiology procedures by deploying evidence based medicine guidelines.
Channeling Imaging Studies to Contracted Teleradiology Groups
Managed Care/Insurance organizations need the ability to route imaging studies to participating teleradiology groups for their professional interpretation of the diagnostic file.
Diagnostic Facility Contract Rates
Managed Care/Insurance organizations will benefit by having the facility contract rates available in the provider profile database enabling them to route patients to providers with preferred contract rates.
Epidemiology Studies
A non-limiting exemplary embodiment of the present disclosure, performs epidemiology studies of medical conditions and diagnoses of various segments of the insured populations utilizing the system.
Conventional attempts to solve at least one of the aforementioned shortcomings are disclosed by PACS software. However, such software includes only an image storage and digital imaging and communications in medicine (DICOM) viewer. See, for example, www.seemyradiology.com.